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Mitra S, Bouck Z, Larney S, Zolopa C, Høj S, Minoyan N, Upham K, Rammohan I, Mok WY, Hayashi K, Milloy MJ, DeBeck K, Scheim A, Werb D. The impact of the COVID-19 pandemic on people who use drugs in three Canadian cities: a cross-sectional analysis. Harm Reduct J 2024; 21:94. [PMID: 38750575 PMCID: PMC11097551 DOI: 10.1186/s12954-024-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic had a disproportionate impact on the health and wellbeing of people who use drugs (PWUD) in Canada. However less is known about jurisdictional commonalities and differences in COVID-19 exposure and impacts of pandemic-related restrictions on competing health and social risks among PWUD living in large urban centres. METHODS Between May 2020 and March 2021, leveraging infrastructure from ongoing cohorts of PWUD, we surveyed 1,025 participants from Vancouver (n = 640), Toronto (n = 158), and Montreal (n = 227), Canada to describe the impacts of pandemic-related restrictions on basic, health, and harm reduction needs. RESULTS Among participants, awareness of COVID-19 protective measures was high; however, between 10 and 24% of participants in each city-specific sample reported being unable to self-isolate. Overall, 3-19% of participants reported experiencing homelessness after the onset of the pandemic, while 20-41% reported that they went hungry more often than usual. Furthermore, 8-33% of participants reported experiencing an overdose during the pandemic, though most indicated no change in overdose frequency compared the pre-pandemic period. Most participants receiving opioid agonist therapy in the past six months reported treatment continuity during the pandemic (87-93%), however, 32% and 22% of participants in Toronto and Montreal reported missing doses due to service disruptions. There were some reports of difficulty accessing supervised consumption sites in all three sites, and drug checking services in Vancouver. CONCLUSION Findings suggest PWUD in Canada experienced difficulties meeting essential needs and accessing some harm reduction services during the COVID-19 pandemic. These findings can inform preparedness planning for future public health emergencies.
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Affiliation(s)
- Sanjana Mitra
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Medicine, University of California, San Diego, USA
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sarah Larney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Département de Médecine Famille et de Médicine d'Urgence, Université de Montréal, Montréal, Canada
| | - Camille Zolopa
- Department of Educational and Counselling Psychology, McGill University, Montréal, Canada
| | - Stine Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Katie Upham
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Wing Yin Mok
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Public Policy, Simon Fraser University, Burnaby, Canada
| | - Ayden Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, United States.
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Trachtenberg E, Ruzal K, Forkosh O, Ben-Ami Bartal I. The effect of a prosocial environment on health and well-being during the first COVID-19 lockdown and a year later. Sci Rep 2024; 14:6565. [PMID: 38503824 PMCID: PMC10951249 DOI: 10.1038/s41598-024-56979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
The outset of the COVID-19 pandemic was characterized by prolonged periods of chronic stress and social isolation. While studies have investigated the changes to well-being (WB) during this period, the impact of the social environment on long-term physical and mental health requires further study. This study aimed to assess the factors influencing WB and health outcomes, with the hypothesis that a positive social environment would play a significant immediate and long-term role in improving WB and preventing the effects of anxiety associated with the pandemic. At time point 1 (April 2020), an Israeli sample of 206 participants (84% female, mean age 31.5) responded to traditional questionnaires assessing mental health and social support. Factors affecting WB were assessed within subjects during the first COVID-19 lockdown for 6 weeks using a daily survey (Beiwe phone application). A year later, in May 2021, at time point 2, the initial questionnaires were readministered to a subset of the same participants (N = 94). We found that anxiety during the first lockdown adversely affected WB and predicted health and WB deterioration a year later. In contrast, a high quality of social relationships was associated with better short- and long-term WB, and mitigated the adverse effects of anxiety. Daily activities, including physical activity, meditation, and romantic relations, were also positively associated with WB during the first lockdown but did not have long-term effects. In summary, our study underscores the enduring health advantages of a positive social environment, particularly during stressful periods. These results have implications for health policymakers: programs which support individuals with high anxiety and low support, by integrating them into community-based interventions, promise to enhance well-being (WB) and health, as well as to fortify the community as a whole.
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Affiliation(s)
- Estherina Trachtenberg
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Keren Ruzal
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Oren Forkosh
- Department of Cognitive and Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Animal Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Ben-Ami Bartal
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel.
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Kenefick HW, Wing A. BeHERE's effective virtual training to build capacity to support people who use drugs in non-substance use disorder settings. Harm Reduct J 2024; 21:38. [PMID: 38351012 PMCID: PMC10863279 DOI: 10.1186/s12954-024-00948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Human service settings not specifically focused on supporting people who use drugs (PWUD), especially those with a substance use disorder (SUD), such as probation and parole services, homeless shelters, and work re-entry and job training programs, offer a unique opportunity to assist this population and prevent overdose deaths. During the COVID-19 pandemic (pandemic), building capacity in such settings for overdose prevention, harm reduction, and to address barriers to treatment, recovery, and support services required that training vendors use a virtual format. Post-pandemic, virtual training remains a cost-effective and convenient alternative to in-person training. The Behavioral Health and Racial Equity (BeHERE) Training Initiative of Health Resources in Action, which offers eight training modules on prevention, recovery, and harm reduction, delivered 224 online trainings between April 2020 and June 2022. METHODS A mixed methods evaluation based upon the Kirkpatrick Training Evaluation Model was employed, which utilized post-training (n = 1272) and follow-up surveys (n = 62), and key informant interviews (n = 35). RESULTS The findings showed BeHERE's trainings were relevant, engaging, and satisfying to trainees; increased their knowledge, skills, and confidence; and influenced workplace performance. Some participants also indicated that the training influenced the effectiveness of their work with clients and other staff. CONCLUSIONS The evaluation identified aspects of training that make a virtual format effective at improving the capacity of non-SUD settings to address substance use and support PWUD. Findings offer insights for those interested in delivery of virtual training, as well as training to influence the practice of human service providers across different settings to support PWUD.
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Affiliation(s)
| | - Alexis Wing
- Health Resources in Action, 2 Boylston Street, Suite 400, Boston, MA, 02116, USA
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Slaunwhite A, Min JE, Palis H, Urbanoski K, Pauly B, Barker B, Crabtree A, Bach P, Krebs E, Dale L, Meilleur L, Nosyk B. Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study. BMJ 2024; 384:e076336. [PMID: 38199614 PMCID: PMC10777271 DOI: 10.1136/bmj-2023-076336] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19. DESIGN Population based retrospective cohort study. SETTING British Columbia, Canada. PARTICIPANTS 5882 people with opioid or stimulant use disorder who received RMG prescriptions for opioids (n=5356) and/or stimulants (n=1061) (535 received both) from 27 March 2020 to 31 August 2021. MAIN OUTCOME MEASURES All cause and overdose specific mortality and acute care visits in the week after RMG opioid or stimulant dispensation. RMG recipients were matched 1:1 with controls through use of high dimensional propensity score matching. Marginal structural models, executed on weekly time steps, were used to measure the effect of dispensations on outcomes. RESULTS RMG opioid dispensations of one day or more were associated with reduced all cause mortality (adjusted hazard ratio 0.39, 95% confidence interval 0.25 to 0.60) and overdose related mortality (0.45, 0.27 to 0.75) in the subsequent week. Dispensations of RMG stimulants (≥1 days) were not significantly associated with reduced all cause mortality (adjusted hazard ratio 0.50, 0.20 to 1.23) or overdose related mortality (0.53, 0.18 to 1.56). The protective effect of RMG opioid dispensations increased with the number of days the medications were dispensed in a given week. People who received four or more days of RMG opioid dispensations had reduced all cause mortality (adjusted hazard ratio 0.09, 0.04 to 0.21) and overdose related mortality (0.11, 0.04 to 0.32) compared with the control group. Opioid RMG dispensations did not significantly modify the odds of all cause or overdose related acute care visits. Dispensations of RMG stimulants were associated with a significant decrease in the odds of acute care visits for any cause but did not affect the odds of overdose related acute care visits. CONCLUSIONS RMG opioid dispensations were associated with reduced overdose related and all cause mortality among a sample of people with opioid use disorder. Pharmaceutical alternatives to the illegal drug supply are promising interventions to reduce mortality in people with opioid use disorder.
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Affiliation(s)
- Amanda Slaunwhite
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Jeong Eun Min
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Heather Palis
- BC Centre for Disease Control, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
- Department of Nursing, University of Victoria, Victoria, BC, Canada
| | - Brittany Barker
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
- First Nations Health Authority, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Paxton Bach
- BC Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Emmanuel Krebs
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Laura Dale
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | | | - Bohdan Nosyk
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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5
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Nagashima K, Yasuno N, Watanabe M. Creating and evaluating the score to assess overdose: the OD score. BMC Emerg Med 2024; 24:5. [PMID: 38185623 PMCID: PMC10773033 DOI: 10.1186/s12873-023-00923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND During disasters (including epidemics such as coronavirus disease 2019), the capacity of emergency departments is exceeded, thereby hindering the administration of appropriate lifesaving measures. Furthermore, the number of overdose patients increases because of the stress overload during emergency situation. The fact that overdose patients are forced to be transported to medical facilities that do not typically treat them is becoming worrisome. Moreover, there is no definitive score for overdose. This study aimed to create a patient-specific scoring system to assess overdose. METHODS This was a retrospective single-center study. The evidence-based OD score was evaluated on a scale of 0-15. Further, logistic analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate the score. RESULTS Overall, 262 patients (including 118 overdose patients) receiving care at the intensive care unit of Japan's Teikyo University Hospital in 2021 were targeted. Regarding the total OD score, ROC analysis revealed a cutoff of 8 (area under the curve [AUC]: 0.99, 95% confidence interval [CI]: 0.980-0.997, sensitivity: 0.95, specificity: 0.95, p < 0.05), which was considered to indicate an overdose. Of the items evaluated in the OD score, the scenario at the location of the patient's discovery (adjusted odds ratio [AOR]: 16.8, 95% CI: 5.0-255.9, p = 0.002) and recent experience of mental anxiety (AOR: 55.7, 95% CI: 2.8-5399.5, p = 0.03) significantly predicted an overdose in multivariable logistic regression analysis. External validation revealed that the OD score could also identify overdose in patients treated in a cohort from 2022 (average cutoff: 8.6, average AUC: 1.0, p < 0.0001). CONCLUSIONS The OD score could accurately assess overdose patients. Medical facilities that do not frequently address overdose patients will benefit from the use of this score.
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Affiliation(s)
- Kazuki Nagashima
- Laboratory of Practical Pharmacy, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8675, Japan.
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Science, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Nobuhiro Yasuno
- Laboratory of Hospital Pharmacy, Faculty of Pharma-Science, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Machiko Watanabe
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Science, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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6
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Nagashima K, Hiruma K, Nakamura E, Watanabe M, Sekine Y. Identification of Factors Necessary for Gatekeeper of Overdose. Biol Pharm Bull 2024; 47:112-119. [PMID: 37967973 DOI: 10.1248/bpb.b23-00530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Overdose has become a global social problem. The Japanese government requires gatekeeper training to detect and prevent indicators of overdose and suicide. However, knowledge of necessary factors for the gatekeeper of overdose (patient intervention) is limited. This study aimed to investigate the characteristics of individuals who experienced intervening persons expected to overdose, and to identify the factors required of gatekeepers. A Google form was used to survey 298 pharmacists and registered sellers in Japan. We searched for factors by logistic analysis. Knowledge of prescription drugs used for overdose was higher among pharmacists than among registered sellers. Conversely, pharmacists and registered sellers had similar knowledge about OTC drugs. Overall multivariate logistic regression analysis revealed countermeasures against overdose at their workplace (odds ratio (OR): 4.01, 95% confidence interval (CI): 2.25-7.15, p < 0.01) and knowledge that overdose is on the rise (OR: 1.93, 95% CI: 1.04-3.69, p < 0.05) to be significantly associated with intervention experience as a gatekeeper. Countermeasures against overdose at their workplace (OR: 2.40, 95% CI: 1.10-5.25, p < 0.05) in pharmacists and years of work experience (OR: 1.13, 95% CI: 1.04-1.24, p < 0.05), countermeasure against overdose at their workplace (OR: 3.43, 95% CI: 1.18-10.0, p < 0.05), and willingness to participate in study sessions and workshops on overdose (OR: 3.50, 95% CI: 1.51-8.10, p < 0.05) in registered seller were significantly associated with intervention experience as a gatekeeper. These results are useful evidences for countermeasures and gatekeeper training for overdose at pharmacies and drugstores in the community.
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Affiliation(s)
- Kazuki Nagashima
- Laboratory of Practical Pharmacy, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Science, Teikyo University
| | | | - Eri Nakamura
- Center for Promotion of Pharmaceutical Education & Research (Clinical Training Unit), Faculty of Pharma-Science, Teikyo University
| | - Machiko Watanabe
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Science, Teikyo University
| | - Yuko Sekine
- Laboratory of Practical Pharmacy, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University
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Armour R, Ghamarian E, Helmer J, Buick JE, Thorpe K, Austin M, Bacon J, Boutet M, Cournoyer A, Dionne R, Goudie M, Lin S, Welsford M, Grunau B. Impact of the COVID-19 pandemic on Canadian emergency medical system management of out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2024; 194:110054. [PMID: 37992799 DOI: 10.1016/j.resuscitation.2023.110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
AIM We sought to describe the impact of the COVID-19 pandemic on the care provided by Canadian emergency medical system (EMS) clinicians to patients suffering out of hospital cardiac arrest (OHCA), and whether any observed changes persisted beyond the initial phase of the pandemic. METHODS We analysed cases of adult, non-traumatic, OHCA from the Canadian Resuscitation Outcome Consortium (CanROC) registry who were treated between January 27th, 2018, and December 31st, 2021. We used adjusted regression models and interrupted time series analysis to examine the impact of the COVID-19 pandemic (January 27th, 2020 - December 31st, 2021)on the care provided to patients with OHCA by EMS clinicians. RESULTS There were 12,947 cases of OHCA recorded in the CanROC registry in the pre-COVID-19 period and 17,488 during the COVID-19 period. We observed a reduction in the cumulative number of defibrillations provided by EMS (aRR 0.91, 95% CI 0.89 - 0.93, p < 0.01), a reduction in the odds of attempts at intubation (aOR 0.33, 95% CI 0.31 - 0.34, p < 0.01), higher rates of supraglottic airway use (aOR 1.23, 95% CI 1.16-1.30, p < 0.01), a reduction in vascular access (aOR for intravenous access 0.84, 95% CI 0.79 - 0.89, p < 0.01; aOR for intraosseous access 0.89, 95% CI 0.82 - 0.96, p < 0.01), a reduction in the odds of epinephrine administration (aOR 0.89, 95% CI 0.85 - 0.94, p < 0.01), and higher odds of resuscitation termination on scene (aOR 1.38, 95% CI 1.31 - 1.46, p < 0.01). Delays to initiation of chest compressions (2 min. vs. 3 min., p < 0.01), intubation (16 min. vs. 19 min., p = 0.01), and epinephrine administration (11 min. vs. 13 min., p < 0.01) were observed, whilst supraglottic airways were inserted earlier (11 min. vs. 10 min., p < 0.01). CONCLUSION The COVID-19 pandemic was associated with substantial changes in EMS management of OHCA. EMS leaders should consider these findings to optimise current OHCA management and prepare for future pandemics.
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Affiliation(s)
- Richard Armour
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Ambulance Victoria, Victoria, Australia; Applied Health Research Centre, Unity Health Toronto, Ontario, Canada.
| | - Ehsan Ghamarian
- Applied Health Research Centre, Unity Health Toronto, Ontario, Canada
| | - Jennie Helmer
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Jason E Buick
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Kevin Thorpe
- Applied Health Research Centre, Unity Health Toronto, Ontario, Canada
| | - Michael Austin
- The Ottawa Hospital, Ontario, Canada; University of Ottawa, Ontario, Canada
| | | | | | - Alexis Cournoyer
- Faculty of Medicine, Université de Montréal, Quebec, Canada; Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Quebec, Canada
| | - Richard Dionne
- The Ottawa Hospital, Ontario, Canada; University of Ottawa, Ontario, Canada; Regional Paramedic Program for Eastern Ontario, Ontario, Canada
| | - Marc Goudie
- Frontenac Paramedic Services, Ontario, Canada
| | - Steve Lin
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, Department of Medicine, McMaster University, Ontario, Canada; Hamilton Health Sciences, Ontario, Canada
| | - Brian Grunau
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada
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8
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Young S, Gomes T, Kolla G, McCormack D, Dodd Z, Raboud J, Bayoumi AM. Initiations of safer supply hydromorphone increased during the COVID-19 pandemic in Ontario: An interrupted time series analysis. PLoS One 2023; 18:e0295145. [PMID: 38113220 PMCID: PMC10729949 DOI: 10.1371/journal.pone.0295145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS Calls to prescribe safer supply hydromorphone (SSHM) as an alternative to the toxic drug supply increased during the COVID-19 pandemic but it is unknown whether prescribing behaviour was altered. We aimed to evaluate how the number of new SSHM dispensations changed during the pandemic in Ontario. METHODS We conducted a retrospective interrupted time-series analysis using provincial administrative databases. We counted new SSHM dispensations in successive 28-day periods from March 22, 2016 to August 30, 2021. We used segmented Poisson regression methods to test for both a change in level and trend of new dispensations before and after March 17, 2020, the date Ontario's pandemic-related emergency was declared. We adjusted the models to account for seasonality and assessed for over-dispersion and residual autocorrelation. We used counterfactual analysis methods to estimate the number of new dispensations attributable to the pandemic. RESULTS We identified 1489 new SSHM dispensations during the study period (434 [mean of 8 per 28-day period] before and 1055 [mean of 56 per 28-day period] during the pandemic). Median age of individuals initiating SSHM was 40 (interquartile interval 33-48) with 61.7% (N = 919) male sex. Before the pandemic, there was a small trend of increased prescribing (incidence rate ratio [IRR] per period 1.002; 95% confidence interval [95CI] 1.001-1.002; p<0.001), with a change in level (immediate increase) at the pandemic date (relative increase in IRR 1.674; 95CI 1.206-2.322; p = 0.002). The trend during the pandemic was not statistically significant (relative increase in IRR 1.000; 95CI 1.000-1.001; p = 0.251). We estimated 511 (95CI 327-695) new dispensations would not have occurred without the pandemic. CONCLUSION The pandemic led to an abrupt increase in SSHM prescribing in Ontario, although the rate of increase was similar before and during the pandemic. The absolute number of individuals who accessed SSHM remained low throughout the pandemic.
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Affiliation(s)
- Samantha Young
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Addiction Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Tara Gomes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | - Zoë Dodd
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
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9
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Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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10
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Cano M, Timmons P, Hooten M, Sweeney K. Drug supply measures and drug overdose mortality in the era of fentanyl and stimulants. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100197. [PMID: 37965239 PMCID: PMC10641574 DOI: 10.1016/j.dadr.2023.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Background Illicitly-manufactured fentanyl and stimulants have replaced prescription opioids as the primary contributors to fatal overdoses in the United States (US), yet the street supply of these substances is challenging to quantify. Building on the foundation of prior research on law enforcement drug reports, the present study compares publicly available forensic laboratory drug report measures to identify which measures account for the most variation in drug overdose mortality between states, within states over time, and in various demographic groups. Methods Drug reports from the National Forensic Laboratory Information System and drug overdose mortality rates from the Centers for Disease Control and Prevention were examined for all US states and the District of Columbia, 2013-2021 (459 state-years). State- and year- fixed effects models regressed drug overdose mortality rates (in the overall population and subpopulations by sex, age, and race/ethnicity) on various drug report measures, including rates per population and proportional shares of drug reports positive for fentanyl/fentanyl-related compounds, heroin, cocaine, methamphetamine, and xylazine. Results For drug overdose death rates in the overall population and nearly all subpopulations examined by sex, race/ethnicity, and age, the model including all drug report proportional measures represented the best-performing model (as identified via the lowest Akaike Information Criterion and highest within R-squared value), followed by the model including only the fentanyl/fentanyl-related compounds proportion. Conclusions Findings support the utility of publicly available drug report composition measures, particularly the proportion of fentanyl/fentanyl-related compounds, as predictors of drug overdose mortality in the US and in various subpopulations.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, 411N, Central Ave Suite 863, Phoenix, AZ 85004, USA
| | | | | | - Kaylin Sweeney
- College of Health Solutions, Arizona State University, USA
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11
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Powell D. Growth in Suicide Rates Among Children During the Illicit Opioid Crisis. Demography 2023; 60:1843-1875. [PMID: 38009202 DOI: 10.1215/00703370-11077660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10-17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation-as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health-were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.
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12
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Baloh J, Charton H, Curran GM. Substance Use Disorder Treatment Programs during a Health Crisis: Response to the COVID-19 Pandemic and Future Implications. Subst Use Misuse 2023; 58:1855-1865. [PMID: 37722809 PMCID: PMC10872742 DOI: 10.1080/10826084.2023.2257305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background: The COVID-19 pandemic rapidly changed how substance use disorder (SUD) treatment services are delivered. In this qualitative study, we examined what changes SUD treatment programs in Arkansas implemented in response to the pandemic, what factors influenced their ability to implement these changes, and their reflections, outlook, and future recommendations. Methods: Between May and August 2020, we conducted semi-structured phone interviews with 29 leaders at 21 SUD programs throughout Arkansas. Interview questions focused on what changes programs implemented in response to the pandemic, barriers and facilitators to implementation, and future outlook. Interviews were thematically analyzed. Results: Programs implemented similar infection control practices, including COVID-19 screening at entry, masks, hand hygiene, and social distancing. Residential programs discontinued outside visitations and capped admissions, and outpatient programs implemented telehealth services. Clients generally responded well to the changes, however many experienced difficulties (e.g., anxiety, lack of access to telehealth). While programs welcomed additional financial support (e.g., CARES act) and looser regulatory restrictions (e.g., telehealth use), many struggled economically due to lower demand and insufficient reimbursement. Programs varied in leadership and staff responses to the pandemic, and in their capacity to implement the changes (e.g., facilities, staffing). Finally, interviewees acknowledged they were unprepared for the pandemic and were uncertain about the future. Conclusions: The insights from the COVID-19 pandemic and SUD programs' responses helps researchers, policymakers and practitioners understand what has happened during the pandemic, how to prepare for future crises, and how to build more resilient SUD and public health systems.
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Affiliation(s)
- Jure Baloh
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heidi Charton
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Geoffrey M. Curran
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
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13
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Sud A, Chiu K, Friedman J, Dupouy J. Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104161. [PMID: 37619440 DOI: 10.1016/j.drugpo.2023.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In passing the Maintstreaming Addiction Treatment Act, the United States has abolished its federal X waiver, considered a major barrier to the wider buprenorphine prescribing needed to respond to opioid-related harms. Advocates for this policy have drawn on the French response of deregulating buprenorphine prescribing to address increasing overdose mortality around the turn of the millennium. So far, such policy advocacy has incompletely accounted for contextual and health system differences between the two countries. METHODS Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US. RESULTS We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality. CONCLUSION Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Kellia Chiu
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States
| | - Julie Dupouy
- University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France; Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
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14
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Clingan SE, Woodruff SI, Gaines TL, Davidson PJ. Detoxification, 12-step meeting attendance, and non-fatal opioid overdoses among a suburban/exurban population with opioid use disorder. J Addict Dis 2023; 41:266-273. [PMID: 35950698 PMCID: PMC9918603 DOI: 10.1080/10550887.2022.2108287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Drug overdoses are the leading cause of injury death in the United States with an estimated 105,752 individuals dying from an overdose in the United States in a 12-month period ending October 2021. Given that people who have opioid use disorder (OUD) are at an increased risk of death, it is crucial to assess risk factors associated with opioid overdose to improve interventions. OBJECTIVES We examine factors associated with non-fatal overdose among a suburban/exurban population with OUD in Southern California. METHODS Participants were recruited by convenience sampling (n = 355) and were interviewed between November 2017 to August 2018. Participants were eligible for the study if they had a history of pharmaceutical opioid use. RESULTS A total of 198 (55.8%) participants reported at least one overdose in their lifetime. A total of 229 participants identified as male, 124 identified as female, and 2 identified as non-binary. When controlling for demographic factors, non-oral opioid administration at first opioid use (AOR 2.82, 95% CI 1.52-5.22), having a history of methadone detoxification, (AOR 2.23, 95% CI 1.27-3.91), history of buprenorphine detoxification (AOR 1.77, 95% CI 1.02-3.07), and history of 12 step attendance (AOR 1.89, 95% CI 1.12-3.20) were found to be independently and positively associated with lifetime opioid overdose. CONCLUSIONS Detoxification with buprenorphine and methadone was found to be associated with having a non-fatal opioid overdose. Buprenorphine and methadone should not be prescribed as a detoxification medication as long-term use of medication for OUD results in better outcomes than medication that is used short-term.
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Affiliation(s)
- Sarah E. Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Susan I. Woodruff
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4119
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Peter J. Davidson
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093
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15
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Bartholomew TS, Tookes HE, Chueng TA, Bluthenthal RN, Wenger LD, Kral AH, Lambdin BH. Availability of telehealth-based services at syringe services programs under the COVID-19 Public Health Emergency. Harm Reduct J 2023; 20:122. [PMID: 37660029 PMCID: PMC10475193 DOI: 10.1186/s12954-023-00861-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION The expanded capacity of syringe services programs (SSPs) in the USA to integrate telehealth services was largely related to flexibility of buprenorphine prescription in response to the COVID-19 pandemic. SSPs demonstrated the potential of using telehealth to reach participants with both medical and non-medical services. The present study examines the implementation of medical and non-medical telehealth-based health services in 2020 at SSPs in the USA and organizational characteristics associated with adopting specific telehealth services. METHODS We administered a cross-sectional survey among all known SSPs operating in the USA as of 2021. The two primary study outcomes were (1) implementation of medical telehealth and (2) implementation of non-medical telehealth in 2020. Medical services included HIV counseling/care, hepatitis C virus (HCV) counseling/care, and buprenorphine. Non-medical services included wellbeing/check-ins, overdose prevention training, health navigation, harm reduction and psychological counseling. Bivariate and multivariable mixed effects logistic regression models were used to directly estimate the odds ratio associated with organizational characteristics on the implementation of telehealth-based health services. RESULTS Thirty percent of programs (n = 290) reported implementing telehealth-based health services. In multivariable logistic regression models, community-based organization SSPs had higher odds of implementing medical (aOR = 4.69, 95% CI [1.96, 11.19]) and non-medical (aOR = 2.18, 95% CI [1.10, 4.31]) health services compared to public health department SSPs. SSPs that received governmental funding had higher odds of implementing medical services via telehealth (aOR = 2.45, 95% CI [1.35, 4.47]) compared to programs without governmental funding. CONCLUSION Community-based organization SSPs and those with government funding had the highest odds of telehealth implementation in response to the COVID-19 Public Health Emergency. Federal, state, and local governments must increase funding for low-barrier venues like SSPs to support telehealth implementation to serve the needs of people who use drugs.
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Affiliation(s)
| | - Hansel E Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | - Teresa A Chueng
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
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16
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Tang VM, Goud R, Zawertailo L, Selby P, Coroiu A, Sloan ME, Chenoweth MJA, Buchman D, Ibrahim C, Blumberger DM, Foll BL. Repetitive transcranial magnetic stimulation for smoking cessation: Next steps for translation and implementation into clinical practice. Psychiatry Res 2023; 326:115340. [PMID: 37454610 DOI: 10.1016/j.psychres.2023.115340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Tobacco smoking is a significant determinant of preventable morbidity and mortality worldwide. It is now possible to modulate the activity of the neurocircuitry associated with nicotine dependence using repetitive Transcranial Magnetic Stimulation (rTMS), a non-invasive neurostimulation approach, which has recently demonstrated efficacy in clinical trials and received regulatory approval in the US and Canada. However there remains a paucity of replication studies and real-world patient effectiveness data as access to this intervention is extremely limited. There are a number of unique challenges related to the delivery of rTMS that need to be addressed prior to widespread adoption and implementation of this treatment modality for smoking cessation. In this paper, we review the accessibility, scientific, technological, economical, and social challenges that remain before this treatment can be translated into clinical practice. By addressing these remaining barriers and scientific challenges with rTMS for smoking cessation and delineating implementation strategies, we can greatly reduce the burden of tobacco-related disease worldwide.
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Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Centre for Addiction and Mental Health, Temerty Centre for Therapeutic Brain Intervention, Canada.
| | - Rachel Goud
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada
| | - Laurie Zawertailo
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Peter Selby
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Adina Coroiu
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada
| | - Matthew E Sloan
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Meghan Jo-Ann Chenoweth
- Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Christine Ibrahim
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Temerty Centre for Therapeutic Brain Intervention, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
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17
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Lott AM, Danner AN, Malte CA, Williams EC, Gordon AJ, Halvorson MA, Saxon AJ, Hagedorn HJ, Sayre GG, Hawkins EJ. Clinician Perspectives on Delivering Medication Treatment for Opioid Use Disorder during the COVID-19 Pandemic: A Qualitative Evaluation. J Addict Med 2023; 17:e262-e268. [PMID: 37579107 PMCID: PMC10417321 DOI: 10.1097/adm.0000000000001156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/18/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic necessitated changes in opioid use disorder care. Little is known about COVID-19's impact on general healthcare clinicians' experiences providing medication treatment for opioid use disorder (MOUD). This qualitative evaluation assessed clinicians' beliefs about and experiences delivering MOUD in general healthcare clinics during COVID-19. METHODS Individual semistructured interviews were conducted May through December 2020 with clinicians participating in a Department of Veterans Affairs initiative to implement MOUD in general healthcare clinics. Participants included 30 clinicians from 21 clinics (9 primary care, 10 pain, and 2 mental health). Interviews were analyzed using thematic analysis. RESULTS The following 4 themes were identified: overall impact of the pandemic on MOUD care and patient well-being, features of MOUD care impacted, MOUD care delivery, and continuance of telehealth for MOUD care. Clinicians reported a rapid shift to telehealth care, resulting in few changes to patient assessments, MOUD initiations, and access to and quality of care. Although technological challenges were noted, clinicians highlighted positive experiences, including treatment destigmatization, more timely visits, and insight into patients' environments. Such changes resulted in more relaxed clinical interactions and improved clinic efficiency. Clinicians reported a preference for in-person and telehealth hybrid care models. CONCLUSIONS After the quick shift to telehealth-based MOUD delivery, general healthcare clinicians reported few impacts on quality of care and highlighted several benefits that may address common barriers to MOUD care. Evaluations of in-person and telehealth hybrid care models, clinical outcomes, equity, and patient perspectives are needed to inform MOUD services moving forward.
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18
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Bowles JM, Kolla G, Smith LR, Scheim A, Dodd Z, Werb D. Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100167. [PMID: 37273749 PMCID: PMC10199487 DOI: 10.1016/j.dadr.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
Background Stigma overwhelmingly affects people who inject drugs. The COVID-19 pandemic posed unique challenges for people who inject drugs, who are already stigmatized as being "dangerous and spreading disease." The present study explored ways in which stigma was experienced by a sample of people who inject drugs in Toronto, Canada following COVID-related public health precaution measures. Methods Qualitative interviews were conducted with people who inject drugs (n = 24) recruited from supervised consumption sites in Toronto, Canada. The semi-structured interview guide focused on the impact of COVID-19 on participants' health and social well-being. Interviews took place six-months after initial COVID-19 precautions (September-October 2020). We used thematic analysis to examine findings, with stigma being an emergent theme. Results Participants described heightened acts of stigma after COVID-19 restrictions were implemented, including feeling treated as "diseased" and the cause of COVID-19's spread. They reported being less likely to receive emergency care during events such as overdoses. Participants perceived increased disease-related stigma evident through actions of stigma, including amplified dehumanization by the public, others avoiding all contact with them, and more discrimination by police and hospital systems. Conclusion Participants provided specific examples of how stigmatizing behaviors harmed them after COVID-19 precautions began. It is plausible that stigma contributed to the dramatic increase in fatal overdoses, difficulty accessing housing, and further difficulty accessing needed healthcare in our setting. Integrating evidence-based harm reduction approaches in areas where stigma is evident might offset harms stemming from disease-related stigma and mitigate these harms during future public health emergencies.
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Affiliation(s)
- Jeanette M. Bowles
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Gillian Kolla
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- University of Victoria Canadian Institute for Substance Use Research: Victoria, BC, Canada
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Ayden Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Zoe Dodd
- MAP Centre for Urban Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
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19
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Palzes VA, Chi FW, Metz VE, Sterling S, Asyyed A, Ridout KK, Campbell CI. Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes. JAMA HEALTH FORUM 2023; 4:e231018. [PMID: 37204804 PMCID: PMC10199344 DOI: 10.1001/jamahealthforum.2023.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Importance Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. Objective To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status. Design, Setting, and Participants This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023. Exposure The expansion of telehealth services during COVID-19 onset. Main Outcomes and Measures Generalized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined. Results Among the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days). Conclusions In this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.
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Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Asma Asyyed
- Northern California Addiction Medicine and Recovery Services, The Permanente Medical Group, Inc, Santa Rosa
| | - Kathryn K. Ridout
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Inc, Santa Rosa, California
| | - Cynthia I. Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Jaffe K, Blawatt S, Lehal E, Lock K, Easterbrook A, MacDonald S, Harrison S, Lajeunesse J, Byres D, Schechter M, Oviedo-Joekes E. "As long as that place stays open, I'll stay alive": Accessing injectable opioid agonist treatment during dual public health crises. Harm Reduct J 2023; 20:51. [PMID: 37060027 PMCID: PMC10104430 DOI: 10.1186/s12954-023-00779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider-client interaction-treatment components made difficult by the pandemic. METHODS Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. RESULTS Qualitative analysis revealed the ways in which the pandemic shaped clients' lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses. CONCLUSION Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.
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Affiliation(s)
- Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Sarin Blawatt
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Eisha Lehal
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin Schechter
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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21
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Stringfellow EJ, Lim TY, DiGennaro C, Hasgul Z, Jalali MS. Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis. PNAS NEXUS 2023; 2:pgad064. [PMID: 37020497 PMCID: PMC10069612 DOI: 10.1093/pnasnexus/pgad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In 2020, the ongoing US opioid overdose crisis collided with the emerging COVID-19 pandemic. Opioid overdose deaths (OODs) rose an unprecedented 38%, due to a combination of COVID-19 disrupting services essential to people who use drugs, continued increases in fentanyls in the illicit drug supply, and other factors. How much did these factors contribute to increased OODs? We used a validated simulation model of the opioid overdose crisis, SOURCE, to estimate excess OODs in 2020 and the distribution of that excess attributable to various factors. Factors affecting OODs that could have been disrupted by COVID-19, and for which data were available, included opioid prescribing, naloxone distribution, and receipt of medications for opioid use disorder. We also accounted for fentanyls' presence in the heroin supply. We estimated a total of 18,276 potential excess OODs, including 1,792 lives saved due to increases in buprenorphine receipt and naloxone distribution and decreases in opioid prescribing. Critically, growth in fentanyls drove 43% (7,879) of the excess OODs. A further 8% is attributable to first-ever declines in methadone maintenance treatment and extended-released injectable naltrexone treatment, most likely due to COVID-19-related disruptions. In all, 49% of potential excess OODs remain unexplained, at least some of which are likely due to additional COVID-19-related disruptions. While the confluence of various COVID-19-related factors could have been responsible for more than half of excess OODs, fentanyls continued to play a singular role in excess OODs, highlighting the urgency of mitigating their effects on overdoses.
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Affiliation(s)
- Erin J Stringfellow
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
| | - Tse Yang Lim
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Catherine DiGennaro
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Zeynep Hasgul
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
| | - Mohammad S Jalali
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
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22
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Mathias CW, Cavazos DM, McGlothen-Bell K, Crawford AD, Flowers-Joseph B, Wang Z, Cleveland LM. Opioid overdose prevention education in Texas during the COVID-19 pandemic. Harm Reduct J 2023; 20:37. [PMID: 36964600 PMCID: PMC10037395 DOI: 10.1186/s12954-023-00769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Distribution of naloxone and training on its proper use are evidence-based strategies for preventing opioid overdose deaths. In-person naloxone training was conducted in major metropolitan areas and urban centers across Texas as part of a state-wide targeted opioid response program. The training program transitioned to a live, virtual format during the COVID-19 public health emergency declaration. This manuscript describes the impact of this transition through analyses of the characteristics of communities reached using the new virtual training format. CASE PRESENTATION Training participant addresses were compared to county rates of opioid overdose deaths and broadband internet access, and census block comparison to health services shortages, rural designation, and race/ethnicity community characteristics. CONCLUSIONS The virtual training format reached more learners than the in-person events. Training reached nearly half of the counties in Texas, including all with recent opioid overdose deaths. Most participants lived in communities with a shortage of health service providers, and training reached rural areas, those with limited broadband internet availability, and majority Hispanic communities. In the context of restrictions on in-person gathering, the training program successfully shifted to a live, online format. This transition increased participation above rates observed pre-pandemic and reached communities with the need for equipping those most likely to witness an opioid overdose with the proper use of naloxone.
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Affiliation(s)
- Charles W Mathias
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7793, San Antonio, TX, 78229, USA.
| | - Diana M Cavazos
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Kelly McGlothen-Bell
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Allison D Crawford
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Brieanna Flowers-Joseph
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Zhan Wang
- Population Health Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Lisa M Cleveland
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
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23
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Friedmann PD, Dunn D, Michener P, Bernson D, Stopka TJ, Pivovarova E, Ferguson WJ, Rottapel R, Hoskinson R, Wilson D, Evans EA. COVID-19 impact on opioid overdose after jail release in Massachusetts. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100141. [PMID: 36879616 PMCID: PMC9968665 DOI: 10.1016/j.dadr.2023.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Introduction Release from incarceration is a high-risk period for opioid overdose. Concern about COVID-19 spread in jails led to early releases; it is unknown whether pandemic era releases of persons with opioid use disorder (OUD) contributed to increases in community overdose rates. Methods Observational data compared overdose rates three months after release among jailed persons with OUD released before (9/1/2019-3/9/2020) and during the pandemic (3/10/2020-8/10/2020) from seven jails in Massachusetts. Data on overdoses come from the Massachusetts Ambulance Trip Record Information System and Registry of Vital Records Death Certificate file. Other information came from jail administrative data. Logistic models regressed overdose on release period, controlling for MOUD received, county of release, race/ethnicity, sex, age, and prior overdose. Results Pandemic releases with OUD had a higher risk of fatal overdose (adjusted odds ratio [aOR] 3.06; 95% CI, 1.49 to 6.26); 20 persons released with OUD (1.3%) experienced a fatal overdose within three months of release, versus 14 (0.5%) pre-pandemic. MOUD had no detectable relationship with overdose mortality. Pandemic release did not impact non-fatal overdose rates (aOR 0.84; 95% CI 0.60 to 1.18), though in-jail methadone treatment was protective (aOR 0.34; 95% CI 0.18 to 0.67). Conclusions Persons with OUD released from jail during the pandemic experienced higher overdose mortality compared to pre-pandemic, but the number of deaths was small. They did not experience significantly different rates of non-fatal overdose. Early jail releases during the pandemic were unlikely to explain much, if any, of the observed increase in community overdoses in Massachusetts.
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Affiliation(s)
- Peter D Friedmann
- University of Massachusetts Chan Medical School - Baystate and Baystate Health, Office of Research, 3601 Main Street, Springfield, MA 01107 USA
| | - Devon Dunn
- Massachusetts Department of Public Health, Office of Population Health - Special Analytic Projects, 250 Washington Street, 6th Floor, Boston, MA 02108 USA
| | - Pryce Michener
- University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Dana Bernson
- Massachusetts Department of Public Health, Office of Population Health - Special Analytic Projects, 250 Washington Street, 6th Floor, Boston, MA 02108 USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Ekaterina Pivovarova
- University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Warren J Ferguson
- University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Rebecca Rottapel
- University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Randall Hoskinson
- University of Massachusetts Chan Medical School - Baystate and Baystate Health, Office of Research, 3601 Main Street, Springfield, MA 01107 USA
| | - Donna Wilson
- University of Massachusetts Chan Medical School - Baystate and Baystate Health, Office of Research, 3601 Main Street, Springfield, MA 01107 USA
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant St, Amherst, MA 01003, USA
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24
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Ali F, Russell C, Law J, Talbot A, Elton-Marshall T, Bozinoff N, Imtiaz S, Rehm J, Giang V, Rush B. Withdrawal Management Practices and Services in Canada: A Cross-Sectional National Survey on the Management of Opioid Use Disorder. CANADIAN JOURNAL OF ADDICTION 2023. [DOI: 10.1097/cxa.0000000000000167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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25
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Monarque M, Sabetti J, Ferrari M. Digital interventions for substance use disorders in young people: rapid review. Subst Abuse Treat Prev Policy 2023; 18:13. [PMID: 36805783 PMCID: PMC9937742 DOI: 10.1186/s13011-023-00518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed. METHODS Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance. RESULTS In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions. CONCLUSIONS While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.
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Affiliation(s)
- Marika Monarque
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Manuela Ferrari
- Douglas Mental Health University Institute, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 Boulevard LaSalle, Perry C3 E-3102, QC H4H 1R3, Montreal, Canada.
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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2023; 48:37-43. [DOI: 10.1136/rapm-2022-103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
ImportanceThe COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts.ObjectiveTo summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada.Evidence reviewWe searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results.FindingsAmong 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each.InterpretationSignificant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves.PROSPERO registration numberCRD42021236464.
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Teck JTW, Zlatkute G, Perez A, Dritschel H, Ghosh A, Potenza MN, Ambekar A, Ekhtiari H, Stein D, Khazaal Y, Arunogiri S, Torrens M, Ferri M, Galea-Singer S, Baldacchino A. Key implementation factors in telemedicine-delivered medications for opioid use disorder: a scoping review informed by normalisation process theory. Lancet Psychiatry 2023; 10:50-64. [PMID: 36526346 DOI: 10.1016/s2215-0366(22)00374-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
Telemedicine could improve access to medications for opioid use disorder (MOUD). Telemedicine-delivered MOUD (TMOUD) has expanded substantially in response to the restrictions imposed by the COVID-19 pandemic on in-person clinical contact, yet this expansion has not happened consistently across all health systems and countries. This Review aims to understand key factors in TMOUD implementation that might explain variations in uptake. We did a scoping review using three English language databases for articles reporting on the implementation of TMOUD services. 57 peer-reviewed articles were identified, subjected to open coding and thematic analysis, and further interpreted through normalisation process theory (NPT). NPT was originally used to evaluate telehealth innovations and has been applied extensively to describe, assess, and develop the implementation potential of a broad range of complex health-care interventions. By categorising our findings according to the four core NPT constructs of coherence, cognitive participation, collective action, and reflexive monitoring, we aim to rationalise the current evidence base to show the workability of TMOUD in practice. We find that variations in TMOUD models in practice depend on organisations' attitudes towards risk, clinicians' tensions around giving up control over standard practices, organisation-level support in overcoming operational and technological challenges, and evaluation methods that might neglect a potential widening of the digital divide.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK; Forward Leeds and Humankind Charity, Durham, UK.
| | - Giedre Zlatkute
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Alberto Perez
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Heidi Dritschel
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA; the Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dan Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Yasser Khazaal
- Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Research Center, Institute of Mental Health, Montréal University, Montréal, QC, Canada
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Melbourne, VIC, Australia
| | - Marta Torrens
- School of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Susanna Galea-Singer
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK; NHS Fife Addiction Services, Leven, UK
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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Schirle L, Kwun S, Suh A, Sanchez-Roige S, Jeffery AD, Samuels DC. Identifying problematic opioid use in electronic health record data: Are we looking in the right place? J Opioid Manag 2023; 19:5-9. [PMID: 36683296 PMCID: PMC9987029 DOI: 10.5055/jom.2023.0754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the value of data obtained outside of regular healthcare visits (clinical communications) to detect problematic opioid use in electronic health records (EHRs). DESIGN A retrospective cohort study. PARTICIPANTS Chronic pain patient records in a large academic medical center. INTERVENTIONS We compared evidence for problematic opioid use in (1) clinic notes, (2) clinical communications, and (3) full EHR data. We analyzed keyword counts and calculated concordance and Cohen's κ between data sources. MAIN OUTCOME MEASURE Evidence of problematic opioid use in EHR defined as none, some, or high. RESULTS Twenty-six percent of records were discordant in determination of problematic opioid use between clinical communications and clinic notes. Of these, 54 percent detected more evidence in clinical communications, and 46 percent in clinic notes. Compared to full EHR review, clinic notes exhibited higher concordance (78 percent; κ = 0.619) than clinical communications (60 percent; κ = 0.290). CONCLUSION Clinical communications are a valuable addition to opioid EHR research.
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Affiliation(s)
- Lori Schirle
- Vanderbilt University School of Nursing, Nashville, Tennessee. ORCID: https://orcid.org/0000-0003-2551-019X
| | - Shinwho Kwun
- Vanderbilt University, Blair School of Music, Nashville, Tennessee
| | - Ashley Suh
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee
| | - Sandra Sanchez-Roige
- Department of Psychiatry, University of California, Oakland, California; Vanderbilt University Medical Center, Division of Genetic Medicine, Nashville, Tennessee
| | - Alvin D Jeffery
- Department of Biomedical Informatics, Vanderbilt University School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David C Samuels
- Department of Molecular Physiology and BioPhysics, Vanderbilt University School of Medicine, Vanderbilt Genetics Institute, Nashville, Tennessee
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Schneider KE, Allen ST, Rouhani S, Morris M, Haney K, Saloner B, Sherman SG. Increased solitary drug use during COVID-19: An unintended consequence of social distancing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103923. [PMID: 36521196 PMCID: PMC9678832 DOI: 10.1016/j.drugpo.2022.103923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, overdose rates substantially increased in the United States. One possible contributor to this phenomenon may be solitary drug use resulting from social distancing efforts to prevent COVID-19 transmission. METHODS We surveyed 458 people who use drugs (PWUD) who were recruited from harm reduction and drug treatment providers located in nine states and the District of Columbia. We assessed if solitary drug use had increased since the start of COVID-19. Associations between increased solitary drug use and sociodemographic characteristics, drug use characteristics, and COVID-19 prevention behaviors were examined using multiple logistic regression. RESULTS Half the sample identified as men (52.7%), White (49.7%), and single (49.3%). The average age was 43.2 (SD:11.8) years. Two-thirds (66.8%) recently injected drugs. 44% reported increased solitary drug use since COVID-19. Significant correlates of increased solitary drug use included being single (adjusted Odds Ratio [aOR]=1.99, 95% Confidence Interval [CI]: 1.33, 2.98), increasing drug use (aOR=2.74, 95% CI: 1.72, 4.37), using more in private locations (aOR=1.91, 95% CI: 1.34, 2.72), and social distancing behaviors (aOR=1.31, 95% CI: 1.11, 1.54). Experiencing homelessness (aOR=0.45, 95% CI: 0.31, 0.65) and identifying as a sexual minority (aOR=0.53, 95% CI: 0.31, 0.93) were associated with being less likely to increase solitary drug use. CONCLUSIONS Solitary drug use increased during the COVID-19 pandemic. Increases in solitary drug use, in the context of a drug market increasingly permeated by fentanyl, indicates an urgent need for comprehensive harm reduction interventions to reduce overdose mortality.
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Affiliation(s)
- Kristin E. Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,Corresponding author
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Katherine Haney
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
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Buchman DZ, Lo S, Ding P, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies, and programs and guidelines. Palliat Med 2022; 37:426-443. [PMID: 36522840 PMCID: PMC9760505 DOI: 10.1177/02692163221143153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. AIM To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. DESIGN Scoping review. DATA SOURCES We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. RESULTS Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. CONCLUSIONS Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics.
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Affiliation(s)
- Daniel Z Buchman
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philip Ding
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Naheed Dosani
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
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Spencer S, Hedden L, Vaughan C, Marshall EG, Lukewich J, Asghari S, Gill P, Buote R, Meredith L, Moritz L, Ryan D, Mathews M. "It was horrible for that community, but not for the way we had imagined": A qualitative study of family physicians' experiences of caring for communities experiencing marginalisation during COVID-19. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100176. [PMID: 36248310 PMCID: PMC9536327 DOI: 10.1016/j.ssmqr.2022.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 response required family physicians (FPs) to adapt their practice to minimise transmission risks. Policy guidance to facilitate enacting public health measures has been generic and difficult to apply, particularly for FPs working with communities that experience marginalisation. Our objective was to explore the experiences of FPs serving communities experiencing marginalisation during COVID-19, and the impact the pandemic and pandemic response have had on physicians' ability to provide care. We conducted semi-structured qualitative interviews with FPs from four Canadian regions, October 2020 through June 2021. We employed maximum variation sampling and continued recruitment until we reached saturation. Interviews explored participants' roles/experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support communities experiencing marginalisation throughout. We used a thematic approach to analyse the data. FPs working with communities experiencing marginalisation expressed the need to continue providing in-person care throughout the pandemic, often requiring them to devise innovative adaptations to their clinical settings and practice. Physicians noted the health implications for their patients, particularly where services were limited or deferred, and that pandemic response policies frequently ignored the unique needs of their patient populations. Pandemic-related precautionary measures that sought to minimise viral transmission and prevent overwhelming acute care settings may have undermined pre-existing services and superseded the ongoing harms that are disproportionately experienced by communities experiencing marginalisation. FPs are well placed to support the development of pandemic response plans that appreciate competing risks amongst their communities and must be included in pandemic planning in the future.
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Affiliation(s)
- Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada,Corresponding author. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Burnaby, BC, V5A 1S6 Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Paul Gill
- Temerty Faculty of Medicine Department of Family & Community Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada,Gateway Centre of Excellence in Rural Health, 74 Kingston Street, Goderich, Ontario, N7A 3K4, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Leslie Meredith
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada,Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada
| | - Maria Mathews
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada
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A concept mapping study of service user design of safer supply as an alternative to the illicit drug market. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103849. [PMID: 36215793 DOI: 10.1016/j.drugpo.2022.103849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Within North America and worldwide, drug-related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply of illicit substances to reduce overdoses with hopes of replacing substances obtained from the illicit drug market. Drug users1 should be at the centre of program and policy decisions related to the development and implementation of safer supply. Yet, there is little empirical research that conceptualizes effective safer supply from their perspectives. METHOD Within a community based participatory approach to research, we conducted a concept mapping study to foreground the perspectives of drug users and develop a conceptual model of effective safer supply. Our team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The focused prompt developed by the team was: "Safe supply would work well if…" Sixty-three drug users participated in three rounds of focus groups as part of the concept mapping process, involving brainstorming, sorting, rating and naming of themes. RESULTS The concept mapping process resulted in six clusters of statements: 1) Right dose and right drugs for me; 2) Safe, positive and welcoming spaces; 3) Safer supply and other services are accessible to me; 4) I am treated with respect; 5) I can easily get my safer supply; and 6) Helps me function and improves my quality of life (as defined by me). The statements within each cluster describe key components central to an effective model of safer supply as defined by drug users. CONCLUSION The results of this study provide insights into key components of effective safer supply to inform planning and evaluation of future safer supply programs informed by drug user perspectives.
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The effects of the COVID-19 pandemic on drug and poison–related deaths in Gold Coast, Australia. Forensic Sci Med Pathol 2022:10.1007/s12024-022-00555-5. [DOI: 10.1007/s12024-022-00555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/20/2022]
Abstract
Abstract
Introduction
COVID-19 is postulated to impact drug- and poison-related deaths. America has reported an increased in drug-related deaths, whereas Australia has reported a decline. Regional studies are scant and may not mirror national data. Characterising drug and poison–related deaths during COVID-19 at a regional level would inform local interventions and policies on the current and future pandemics.
Methods
A 4-year retrospective study from January 1, 2018, to December 31, 2019 (pre-COVID-19 pandemic) and from January 1, 2020, to December 31, 2021 (COVID-19 pandemic) of all drug and poison–related deaths admitted to the Gold Coast University Hospital under Coronial investigation.
Results
Drug and poison–related deaths increased in both the proportion and absolute numbers before and during the COVID-19 pandemic. There was no statistical difference in age, sex, location of death, manner of death and classification of drugs and poison implicated.
Conclusions
Although there is an increase in drug and poison–related deaths, the overall demographic and pattern have not changed. Further studies to account for the variation may enable implementation of targeted public health interventions to address the burden of related deaths in regional settings in the context of future pandemics.
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Marsden J, Brown J, Clark L, Cousijn J, Hall W, Hickman M, Holmes J, Humphreys K, Jackson SE, Peacock A, Tucker J. The impact of the COVID-19 pandemic on addictive disorders-an update. Addiction 2022; 117:2762-2766. [PMID: 36068188 DOI: 10.1111/add.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Luke Clark
- University of British Columbia, Vancouver, BC, Canada
| | | | - Wayne Hall
- University of Queensland, Brisbane, QLD, Australia
| | | | | | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA
| | | | - Amy Peacock
- University of New South Wales, Sydney, NSW, Australia
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Buckley C, Ye Y, Kerr WC, Mulia N, Puka K, Rehm J, Probst C. Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment, and race and ethnicity for the United States 2000-2019. BMC Med 2022; 20:405. [PMID: 36280833 PMCID: PMC9590383 DOI: 10.1186/s12916-022-02590-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The ongoing opioid epidemic and increases in alcohol-related mortality are key public health concerns in the USA, with well-documented inequalities in the degree to which groups with low and high education are affected. This study aimed to quantify disparities over time between educational and racial and ethnic groups in sex-specific mortality rates for opioid, alcohol, and combined alcohol and opioid poisonings in the USA. METHODS The 2000-2019 Multiple Cause of Death Files from the National Vital Statistics System (NVSS) were used alongside population counts from the Current Population Survey 2000-2019. Alcohol, opioid, and combined alcohol and opioid poisonings were assigned using ICD-10 codes. Sex-stratified generalized least square regression models quantified differences between educational and racial and ethnic groups and changes in educational inequalities over time. RESULTS Between 2000 and 2019, there was a 6.4-fold increase in opioid poisoning deaths, a 4.6-fold increase in combined alcohol and opioid poisoning deaths, and a 2.1-fold increase in alcohol poisoning deaths. Educational inequalities were observed for all poisoning outcomes, increasing over time for opioid-only and combined alcohol and opioid mortality. For non-Hispanic White Americans, the largest educational inequalities were observed for opioid poisonings and rates were 7.5 (men) and 7.2 (women) times higher in low compared to high education groups. Combined alcohol and opioid poisonings had larger educational inequalities for non-Hispanic Black men and women (relative to non-Hispanic White), with rates 8.9 (men) and 10.9 (women) times higher in low compared to high education groups. CONCLUSIONS For all types of poisoning, our analysis indicates wide and increasing gaps between those with low and high education with the largest inequalities observed for opioid-involved poisonings for non-Hispanic Black and White men and women. This study highlights population sub-groups such as individuals with low education who may be at the highest risk of increasing mortality from combined alcohol and opioid poisonings. Thereby the findings are crucial for the development of targeted public health interventions to reduce poisoning mortality and the socioeconomic inequalities related to it.
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Affiliation(s)
- Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, Toronto, Canada.,Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada. .,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. .,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Rahimi-Ardabili H, Feng X, Nguyen PY, Astell-Burt T. Have Deaths of Despair Risen during the COVID-19 Pandemic? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12835. [PMID: 36232135 PMCID: PMC9564909 DOI: 10.3390/ijerph191912835] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates COVID-19-related disruption may not have influenced suicide rates so far, but there have been reports of increased drug-related and liver disease mortality. Minority groups and women were more vulnerable, indicating the need for stronger equity focus on pandemic recovery and resilience strategies. Further high-quality studies with longer-term follow-up, especially from low-income countries, will inform these strategies.
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Affiliation(s)
- Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong 2522, Australia
| | - Phi-Yen Nguyen
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong 2522, Australia
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Redona PT, Woods C, Jackson D, Hayman J, Usher K. Comparison of Stimulant-Related Presentations to Victorian Emergency Departments Pre-pandemic and During the COVID-19 Pandemic. Cureus 2022; 14:e28813. [PMID: 36225464 PMCID: PMC9534731 DOI: 10.7759/cureus.28813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
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Mancheño-Velasco C, Dacosta-Sánchez D, Blanc-Molina A, Narvaez-Camargo M, Lozano-Rojas ÓM. Changes in the Care Activity in Addiction Centers with Dual Pathology Patients during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154341. [PMID: 35893432 PMCID: PMC9369119 DOI: 10.3390/jcm11154341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health care provision during the COVID-19 pandemic and confinement has led to significant changes in the activity of addiction centers. These changes in healthcare activity may have had a greater impact on patients with dual pathology. The aim of this study is to compare the treatment indicators of patients with dual pathology in addiction centers during the pre-confinement, confinement, and post-confinement periods. METHODS A retrospective observational study was conducted for the period between 1 February 2019 and 30 June 2021. A total of 2785 patients treated in specialized addiction services were divided into three periods according to their time of admission: pre-confinement, confinement, and post-confinement. RESULTS During the pre-pandemic period, the addiction centers attended to an average of 121.3 (SD = 23.58) patients, decreasing to 53 patients during confinement (SD = 19.47), and 80.69 during the post-confinement period (SD = 15.33). The number of appointments scheduled monthly for each patient decreased during the confinement period, although this number increased after confinement. There was a reduction in the number of toxicological tests carried out both during and after confinement (except for alcohol). CONCLUSIONS The results show a reduction in the number of patients seen and the care activity delivered to dual diagnosis patients. These results, which were caused by the COVID-preventive measures, may affect the progress and recovery of dual patients. A greater investment is needed to bring the care activity up to the standards of the years prior to confinement.
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Affiliation(s)
- Cinta Mancheño-Velasco
- Department of Clinical and Experimental Psychology, University of Huelva, 21004 Huelva, Spain; (C.M.-V.); (D.D.-S.); (A.B.-M.); (M.N.-C.)
| | - Daniel Dacosta-Sánchez
- Department of Clinical and Experimental Psychology, University of Huelva, 21004 Huelva, Spain; (C.M.-V.); (D.D.-S.); (A.B.-M.); (M.N.-C.)
| | - Andrea Blanc-Molina
- Department of Clinical and Experimental Psychology, University of Huelva, 21004 Huelva, Spain; (C.M.-V.); (D.D.-S.); (A.B.-M.); (M.N.-C.)
| | - Marta Narvaez-Camargo
- Department of Clinical and Experimental Psychology, University of Huelva, 21004 Huelva, Spain; (C.M.-V.); (D.D.-S.); (A.B.-M.); (M.N.-C.)
| | - Óscar Martín Lozano-Rojas
- Department of Clinical and Experimental Psychology, University of Huelva, 21004 Huelva, Spain; (C.M.-V.); (D.D.-S.); (A.B.-M.); (M.N.-C.)
- Research Center on Natural Resources, Health and the Environment, University of Huelva, 21004 Huelva, Spain
- Correspondence:
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Shanthanna H, Nelson AM, Kissoon N, Narouze S. The COVID-19 pandemic and its consequences for chronic pain: a narrative review. Anaesthesia 2022; 77:1039-1050. [PMID: 35848380 PMCID: PMC9350079 DOI: 10.1111/anae.15801] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID-19 pandemic for chronic pain. Publications were identified related to the COVID-19 pandemic influence on the burden of chronic pain, development of new-onset pain because of long COVID with proposed mechanisms and COVID-19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS-CoV-2 infection could be caused by 'systemic inflammatory-immune mechanisms', 'direct neuropathic mechanisms' or 'secondary mechanisms due to the viral infection or treatment'. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS-CoV-2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New-onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism-based treatments within the domain of multidisciplinary care.
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Affiliation(s)
- H Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - A M Nelson
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, CA, USA
| | - N Kissoon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - S Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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Durand L, Keenan E, Boland F, Harnedy N, Delargy Í, Scully M, Mayock P, Ebbitt W, Vázquez MO, Corrigan N, Killeen N, Pate M, Byrne P, Cousins G. Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103768. [PMID: 35738029 PMCID: PMC9212711 DOI: 10.1016/j.drugpo.2022.103768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/30/2022]
Abstract
BACKGROUND Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. The contingency guidelines deviated, across multiple clinical domains, from pre-pandemic clinical guidelines published in 2016. The objectives of this study are to (1) identify changes introduced to OAT clinical guidelines in Ireland during the pandemic; and (2) develop consensus on whether the new recommendations should be retained beyond the pandemic, using a national Delphi consensus methodology. METHODS Clinical guidance recommendations ('statements') were generated by comparing the newly established contingency guidelines with the national 2016 Clinical Guidelines for OAT. Over two rounds of on-line Delphi testing, a panel of experts (people currently accessing OAT, psychiatrists, general practitioners, community pharmacists, a nurse, a psychologist and support/key workers) independently rated their agreement with each statement and provided comments. Statements with a median score of 4 or 5 and a lower quartile of ≥4 were classified as having reached consensus. RESULTS Forty-eight panel members were recruited, with a high participation level at Round 2 (90%, n=43). Consensus was achieved for 12 of the 19 statements at Round 1. The 7 remaining statements were revised, with 2 new statements, resulting in 9 statements at Round 2. Four statements reached consensus at Round 2. The final list includes 16 clinical guidance statements; 9 relating to assessment, 3 to OAT drug choice and dosing, 1 to take-away doses, 2 to overdose prevention and 1 to the continuation of e-prescriptions. CONCLUSIONS A wide range of stakeholders involved in the delivery and receipt of OAT agreed on 16 clinical guidance statements for inclusion in OAT clinical guidelines as we move beyond the pandemic, rather than reverting to pre-pandemic guidelines. The agreed statements relate to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Notably, consensus was not achieved for OAT drug dosage and frequency of urine testing during the stabilisation and maintenance phase of care.
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Affiliation(s)
- Louise Durand
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland
| | - Eamon Keenan
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Fiona Boland
- RCSI Data Science Centre and Department of General practice, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street Lower, Dublin 2, D02 DH60, Ireland
| | - Norma Harnedy
- HSE Addiction Services, PO Box 486, Corporate House, Mungret Street, Limerick, V94 PV34, Ireland
| | - Íde Delargy
- Irish College of General Practitioners, Lincoln Place, Dublin 2, D02 XR68, Ireland
| | - Mike Scully
- National Drug Treatment Centre, 30/31 Pearse street, Dublin 2, D02 NY26, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, 3/4 Foster place, Trinity College Dublin Dublin 2, Ireland
| | - William Ebbitt
- National Drug Treatment Centre, 30/31 Pearse street, Dublin 2, D02 NY26, Ireland
| | - María Otero Vázquez
- UISCE, National Advocacy Service for People who use Drugs in Ireland, 8 Cabra road, Dublin 7, D07 T1W2, Ireland
| | - Nicola Corrigan
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Nicki Killeen
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Muriel Pate
- Health Service Executive, National Quality and Patient Safety Directorate, Dr. Steeven's Hospital, Dublin 8, D08 W2A8, Ireland
| | - Paula Byrne
- Merchants Quay Ireland Head Office, Merchants Court, 24 Merchants Quay, Dublin 8, D08 × 7YK, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland.
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Bydon M, Durrani S, Mualem W. Commentary: Machine Learning to Predict Successful Opioid Dose Reduction or Stabilization After Spinal Cord Stimulation. Neurosurgery 2022; 91:e41-e42. [PMID: 35510947 DOI: 10.1227/neu.0000000000001989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sulaman Durrani
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William Mualem
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Coburn SB, Manabe YC, Laeyendecker O, Sherman SG, Baker OR, Quinn TC, Graham LA, Dennis Thomas F, Southall P, Weedn VW, Ehsani J, Klock E, Li R, Shields WC, Michael JP, Li L, Althoff K. Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Seroprevalence in Decedents Undergoing Forensic Postmortem Examination: Feasibility for 
Real-Time Pandemic Surveillance. Open Forum Infect Dis 2022; 9:ofac142. [PMID: 35415200 PMCID: PMC8995069 DOI: 10.1093/ofid/ofac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Population-based seroprevalence studies offer comprehensive characterization of coronavirus disease 2019 (COVID-19) spread, but barriers exist and marginalized populations may not be captured. We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seroprevalence among decedents in Maryland over 6 months in 2020. Methods Data were collected on decedents undergoing forensic postmortem examination in Maryland from 24 May through 30 November 2020 from whom a blood specimen could be collected. Those with available blood specimens were tested with the CoronaCHEK lateral flow antibody assay. We assessed monthly seroprevalence compared to the statewide estimated number of cases and proportion of positive test results (testing positivity). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for associations of demographic characteristics, homelessness, and manner of death with SARS-CoV-2 antibodies. Results Among 1906 decedents, 305 (16%) were positive for SARS-CoV-2 antibodies. Monthly seroprevalence increased from 11% to 22% over time and was consistently higher than state-level estimates of testing positivity. Hispanic ethnicity was associated with 2- to 3.2-fold higher seropositivity (P < .05) irrespective of sex. Deaths due to motor vehicle crash were associated with 62% increased seropositivity (aPR, 1.62 [95% CI, 1.15–2.28]) vs natural manner of death. Though seroprevalence was lower in decedents of illicit drug overdose vs nonoverdose in early months, this shifted, and seroprevalence was comparable by November 2020. Conclusions Decedents undergoing forensic postmortem examination, especially those dying due to motor vehicle trauma, may be a sentinel population for COVID-19 spread in the general population and merits exploration in other states/regions.
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Affiliation(s)
- Sally B Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Owen R Baker
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas C Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Pamela Southall
- Office of the Chief Medical Examiner, Maryland Department of Health, Baltimore, Maryland, USA
| | - Victor W Weedn
- University of Maryland Baltimore Graduate School, Baltimore, Maryland, USA
| | - Johnathon Ehsani
- Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ethan Klock
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rong Li
- Office of the Chief Medical Examiner, Maryland Department of Health, Baltimore, Maryland, USA
| | - Wendy C Shields
- Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey Paul Michael
- Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ling Li
- Office of the Chief Medical Examiner, Maryland Department of Health, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Moallef S, DeBeck K, Fairbairn N, Cui Z, Brar R, Wilson D, Johnson C, Milloy MJ, Hayashi K. Inability to contact opioid agonist therapy prescribers during the COVID-19 pandemic in a Canadian setting: a cross-sectional analysis among people on opioid agonist therapy. Addict Sci Clin Pract 2022; 17:73. [PMID: 36522789 PMCID: PMC9751503 DOI: 10.1186/s13722-022-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and consequent public health response may have undermined key responses to the protracted drug poisoning crisis, including reduced access to opioid agonist therapy (OAT) among people with opioid use disorder. Our study objectives were to estimate the prevalence of and identify factors associated with inability to contact OAT prescribers when in need among people on OAT in a Canadian setting during the dual public health crises. METHODS Survey data were collected from three prospective cohort studies of community-recruited people who use drugs between July and November 2020, in Vancouver, Canada. A multivariable logistic regression analysis was used to identify potential factors associated with inability to contact OAT prescribers among patients who accessed OAT in the past 6 months. RESULTS Among 448 respondents who reported accessing OAT in the past 6 months, including 231 (54.9%) men, 85 (19.0%) reported having been unable to contact OAT prescribers when needed, whereas 268 (59.8%) reported being able to talk to their prescriber when needed, and 95 (21.2%) reported that they did not want to talk to their medication prescriber in the previous 6 months. Among those who reported inability to contact prescribers, 45 (53.6%) reported that their overall ability to contact prescribers decreased since the start of the pandemic. In multivariable analyses, factors independently associated with inability to talk to OAT prescribers included: chronic pain (Adjusted Odds Ratio [AOR] = 1.82; 95% Confidence Interval [CI] 1.02, 3.27), moderate to severe symptoms of depression or anxiety (AOR = 4.74; 95% CI 2.30, 9.76), inability to access health/social services (AOR = 2.66; 95% CI 1.41, 5.02), and inability to self-isolate or socially distance most or all of the time (AOR = 2.13; 95% CI 1.10, 4.14). CONCLUSIONS Overall, approximately one fifth of the sample reported inability to contact their OAT prescribers when needed, and those people were more likely to have co-occurring vulnerabilities (i.e., co-morbidities, inability to access health/social services) and higher vulnerability to COVID-19. Interventions are needed to ensure optimal access to OAT and mitigate the deepening health inequities resulting from the COVID-19 pandemic and the escalating drug poisoning crisis.
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Affiliation(s)
- Soroush Moallef
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Kora DeBeck
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494School of Public Policy, Simon Fraser University, Burnaby, BC Canada
| | - Nadia Fairbairn
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Zishan Cui
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Rupinder Brar
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada ,grid.417243.70000 0004 0384 4428Vancouver Coastal Health Authority, Vancouver, BC Canada
| | - Dean Wilson
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Cheyenne Johnson
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, BC Canada
| | - M.-J. Milloy
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Kanna Hayashi
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
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Sanchez K, da Graca B, Hall LR, Bennett MM, Powers MB, Warren AM. The Pandemic Experience for People with Depressive Symptoms: Substance Use, Finances, Access to Treatment, and Trusted Sources of Information. Subst Abuse 2022; 16:11782218221126973. [PMID: 36188442 PMCID: PMC9520161 DOI: 10.1177/11782218221126973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/28/2022] [Indexed: 11/17/2022]
Abstract
Background: Mental health impacts of the COVID-19 pandemic are well recognized, but little is known about the pandemic experience among people experiencing mental health symptoms. Methods: In June 2020, a national sample of 5023 U.S. adults, including 785 scoring ⩾10 on the PHQ-8 for symptoms of depression, completed survey measures related to their pandemic experience. Results: After adjusting for sociodemographic characteristics, aspects of the COVID-19 pandemic experience for which participants scoring PHQ-8 ⩾ 10 had the greatest increase in odds of reporting moderate/severe negative impacts included: mental health treatment access (odds ratio [OR], 95% confidence interval [CI] = 8.81, 6.70-11.57), family stress/discord (OR, 95% CI = 5.21, 4.24-6.42), food access (OR, 95% CI = 3.76, 2.97-4.77), and income/employment (OR, 95% CI = 3.19, 2.66-3.83). They were also significantly more likely to report increased use of prescription painkillers (OR, 95% CI = 8.46, 4.50-15.92) and other drugs (OR, 95% CI = 4.43, 2.85-6.89), and less trust in healthcare authorities/providers, family/friends, and employers, and more trust in websites/blogs/social media, for COVID-19 information ( P-values < .05). Conclusions: The interplay among depressive symptoms, substance use, lack of trust in healthcare authorities, and negative impact of the pandemic on family, finances, and access to mental health treatment and food indicate the need for robust social and behavioral health safety nets to buffer communities from the shadow epidemics of depression, family violence, and overdose deaths during public health disasters.
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Affiliation(s)
- Katherine Sanchez
- Baylor Scott & White Research Institute, Dallas, TX, USA
- University of Texas at Arlington, School of Social Work, Arlington, TX, USA
| | | | - Lauren R Hall
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Mark B Powers
- Baylor Scott & White Research Institute, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Texas A&M University—College of Medicine, Dallas, TX, USA
| | - Ann Marie Warren
- Baylor Scott & White Research Institute, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Texas A&M University—College of Medicine, Dallas, TX, USA
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